Healthcare Provider Details

I. General information

NPI: 1437425360
Provider Name (Legal Business Name): JEFFERSON UNIVERSITY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 CHESTNUT ST 14TH FLOOR
PHILADELPHIA PA
19106-4495
US

IV. Provider business mailing address

615 CHESTNUT ST 14TH FLOOR
PHILADELPHIA PA
19106-4495
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-9655
  • Fax:
Mailing address:
  • Phone: 215-955-9655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StatePA

VIII. Authorized Official

Name: MR. JOHN OGUNKEYE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 215-955-2562